High Complexity Hospital Research Articles

Estancia hospitalaria y funcionalidad en pacientes con retraso en el inicio de tratamiento de fisioterapia

ObjectiveTo evaluate the association between hospital stay, functional status and physical therapy delay (PT delay) in patients admitted to a surgery unit of a high complexity hospital. Materials and methodsObservational, analytic and cross-sectional study. We included 279 patients (124 women). Days of PT delay (calculated as the difference between hospital admission and start of PT), days of bed rest, prolonged hospital stay (75th percentile of bed rest days), and functional status were registered to investigate the influence of PT delay on these variables. ResultsThe number of days of PT delay was strongly associated with the number of bed rest days (r2 = 0.74, p < 0.05). Moreover, a PT delay of five days or more was associated with extended lengths of stay in our sample (p < 0.05). However, physical therapy had similar effects on functional status, even when there were PT delays (p > 0.05). ConclusionsPT delay is associated with extended length of stay in patients admitted to a surgery unit of a high complexity hospital. Future studies should investigate the associated factors that could explain the occurrence of PT delays in surgical patients.

Maternal Mortality in Paraguay tendencies and risk factors: 2004-2015

Abstract Background Maternal mortality remains a serious challenge worldwide, it being part of the Sustainable Development Goals. Progress is tracked through maternal mortality ratios (MMR), which demonstrate the current development of a health system. Our study describes tendencies and factors involved in the MMR in Paraguay, South America. Methods A retrospective cross-sectional study was undertaken. Data were extracted from the national system of vital statistics published by the Ministry of Public Health and Social Welfare. MMR was expressed as the number of maternal deaths per 100,000 live births. The causes of maternal deaths were classified according to the CIE-10. The tendency and fluctuations of the variables were analyzed through Pearson and Spearman correlations. A significance level of 5% was established. Results During the period of 2004-2015 in Paraguay there was a significant reduction in the tendency of the number of maternal deaths (r= -0.895; p &amp;lt; 0.001) with a decrease of 37.1%; Accordingly, there is a decreased tendency of the MMR (r= -0.929; p &amp;lt; 0.001) with a reduction of 45.4% and an annual mean decrease of 3.95%. It was observed that women aged 40 years and older and women characterized as single possessed a higher MMR, with each group showing 317.7/100 000 and 377.5/100 000, respectively. The 75% of death causes were Postpartum Hemorrhage, Eclampsia, Concurrent maternal deaths, Abortion and Puerperal Sepsis. Conclusions Our study showed significant decreased tendency of MMR, although remaining high compared to high income countries. More studies to support this result are recommended due to the difference with international estimates. The main causes of death showed the need to strengthen prenatal follow-up in primary care far from high-complexity hospitals. Key messages Our study describes the situation on Maternal Mortality in a developing country, showing the importance of health care access and prenatal follow up for preventable complications. Our work showed the urgent need for more studies about abortion prevalence and also to determine the cause of higher MMR on single women in our country.

Validation of the Status epilepticus severity score (STESS) at high-complexity hospitals in Medellín, Colombia

PurposeThe Status Epilepticus Severity Score (STESS) is one of the most well-known clinical scoring systems to predict mortality in status epilepticus (SE). The objective of this study was to validate STESS in a Colombian population. MethodWe evaluated historical data of adult patients (age ≥16 years) with a clinical or electroencephalographic diagnosis of SE admitted between 2014 and 2017. Prospectively, we included patients admitted from January to June of 2018. The primary outcome was in-hospital mortality. Receiver operating characteristic (ROC)-analysis, determination of best cutoff values, sensitivity, specificity, and positive and negative likelihood ratios were performed. ResultsThe sample was 395 patients, with in-hospital mortality of 16.8 %. The area under the ROC curve for STESS was 0.84. A cutoff point of ≥3 produced the highest sensitivity of 84.9 % (95 % CI 73.9 %-92.5 %) and a specificity of 65.7 % (95 % CI 60.2 %–70.8 %), with a positive likelihood ratio of 2.5 and a negative likelihood ratio of 0.2. ConclusionsSTESS is a useful tool to predict mortality in patients with SE. In Medellin, Colombia, a STESS < 3 allows the identification of the patients who survive reliably. Those patients with a score <3 may have a better prognosis, and treatment with fewer side effects than anaesthetics could be suggested, always remembering the importance of the treating physician's clinical judgement.

Contextual factors favouring success in the accreditation process in Colombian hospitals: a nationwide observational study

BackgroundTo identify context factors associated with and predicting success in the hospital accreditation process, and to contribute to the understanding of the relative relevance of context factors and their organizational level in the success of QI initiatives.MethodsAnalytical study of cases and controls in a sample of hospitals of medium and high complexity in Colombia. Cases (n = 16) are accredited hospitals by the time of preparation of the study (2016) and controls (n = 38) are similar facilities, which have not succeeded to obtain accreditation. Eligibility criteria for both groups included complexity (medium and high), having emergency services, an official quality assurance license, and being in operation for at least 15 years. Besides eligibility criteria, geographical location, and type of ownership (public/private) are used to select controls to match cases.Context measures are assessed using a survey instrument based on the MUSIQ model (“Model for Understanding Success in Quality”) adapted and tested in Colombia. Statistical analysis includes descriptive measures for twenty-three context factors, testing for significant statistical differences between accredited and non-accredited hospitals, and assessing the influence and strength of association of context factors on the probability of success in the accreditation process. A multivariate model assesses the predictive probability of achieving accreditation.ResultsEighteen (78.3%) of the twenty-three context factors are significantly different when comparing cases and controls hospitals, particularly at the Microsystem level; all factors are statistically significant in favor of accredited hospitals. Five context factors are strongly associated to the achievement of accreditation but in the logistic multivariable model, only two of them remain with significant OR, one in the Macrosystem, “Availability of economic resources for QI” (OR: 22.1, p: 0,005), and the other in the Microsystem, “Involvement of physicians” (OR: 4.9, p: 0,04).ConclusionThis study has applied an instrument, based on the MUSIQ model, which allows assessing the relevance of different context factors and their organizational level in hospitals, to explain success in the accreditation process in Colombia. Internal macrosystem and microsystem seem to be more relevant than external environment factors.

Clinical-epidemiological profile of the oncogeriatric patient served in high complexity public hospitals in the State of Pará in the historical series 2014-2018

Introduction: Cancer is classified as a set of cells that have a disordered growth and without specific functions, in which they affect the systems, being that the main population affected is the elderly, due to the associated risk factors, being highlighted the process of cell aging. Objective: to trace the clinical-epidemiological profile of the oncogeriatric patient seen in public hospitals of high complexity in the State of Pará, in the 2014-2018 historical series. Methodology: This is an epidemiological, descriptive retrospective study with a quantitative approach. The study was carried out in the month of June 2020 with information from secondary data, coming from the Hospital Cancer Registry Computerization System for oncogeriatric patients seen in high complexity hospitals in the state of Pará in the period from 2014 to 2018. Results: if the total of 8,184 oncogeriatrics patients seen in hospitals in Pará and the distribution of sociodemographic data found the predominance of the male population, in the age group between 60 and 69 years old, brown race, most have only incomplete fundamental level. Conclusion: It is necessary for professionals to carry out health education practices for this public, in order to raise awareness and encourage self-care, so that these rates are overcome and they can age with a better quality of life.

Factores asociados a la mortalidad en el primer año postrasplante cardíaco

IntroductionThe survival rate in the first year after heart transplant is between 81% and 85%. The main causes of mortality are infections and failure of the graft. ObjectiveTo determine the risk factors associated with mortality at one year post- cardiac transplant in a high complexity hospital in south-west Colombia. MethodsA retrospective cohort study was performed on patients with a heart transplant carried out between 1996 and 2015. Information was obtained on the characteristics of the donor, recipient, and surgical procedure. A Cox regression was performed, with the event of interest being mortality in the first year of follow-up. In the multivariate analysis, variables were included that had a P≤ .20 and clinical significance. ResultsThe study included a total of 158 patients, with a median age of 50 years (IQR: 39-57), of whom 76% were males. The most common origin was idiopathic heart failure (45%). The median time of ischaemia was 187minutes (IQR: 142-300). The mortality was 24% and was mainly due to infections (29%). There were factors associated with the congenital heart failure mortality such as origin of heart failure (P=.048), history of diabetes mellitus (P=.001), previous cardiac surgery (P=.023), ischaemia time greater than 150minutes (P=.038), and the male recipient / female donor ratio (P=.022). ConclusionsThe factors associated with higher mortality in the first year post-cardiac transplant were: origin of heart failure due to congenital heart disease, history of diabetes mellitus, previous cardiac surgery, the male recipient / female donor ratio, and an ischaemia time greater than 150minutes.

PNS185 DO BRAZILIAN HEALTH INSTITUTIONS DELIVER QUALITY SERVICES?

Delivery of high quality healthcare has been associated with improved health outcomes and higher institutional performance. The Association of Self-funded Health Plans in Paraná (Brazil) has implemented the “Evaluation Program of Health Services” (UNIPLUS Program) since 1999 as a way to measure the quality of healthcare delivery for inpatients. Our objective was to analyze the performance of 25 Brazilian health institutions (BHI) located in the southern region of the country in the UNIPLUS Program between 2013 and 2015. We used a semi-structured form with distinct questions related to: a) BHI classification; b) operational/functional structure of BHI; c) human and material resources of BHI; d) BHI compliance with the UNIPLUS Program indicators; and e) self-sufficiency classification of BHI. BHI were classified into three categories: (i) high complexity hospitals – HCH (48%), (ii) general hospitals - GH (40%) and (iii) general healthcare delivery (non-hospital) - GHD (12%). Among the HCHs, 16.7% and 8.3% have no coronary Intensive Care Unit (ICU) and hemodialysis service, respectively. Among the GHs, 10% and 40% do not have an emergency room and general ICU, respectively. Among GHDs, 66.7% do not have a collective inpatient unit. The greatest shortcomings of BHIs are in human and material resources and in indicator compliance so that the indicators 'access', 'equity' and 'patient centrality' presented results below 8%. Finally, because of these results, only 44%, 12% and 12% of BHIs classified as HCH, GH and GHD, respectively, were measured as high quality healthcare BHI. The quality measurement achieved by the UNIPLUS Program is effective and shows that BHIs need to increase the quality of health services they provide to Brazilian people. Since it was first implemented in 1999, the UNIPLUS Program has undergone by two certification processes to improve its methodology. Attributes related to patient safety need to be included in future editions.

Undertriage as quality of care parameter in an emergency department

Undertriage or the underestimation of the urgency of the condition of a person arriving in an emergency department (ED) represents a measure of quality care. To estimate the prevalence of undertriage in a high complexity hospital of Argentina; to describe characteristics and mortality of these patients. All consultations admitted to the ED during 2014 were analyzed. Those assigned to a lower level of admission risk (classified as Emergency Severity Index -ESI- 3 to 5) but required hospitalization in intensive care units (ICU) as the first hospitalization place were considered as an undertriage. A random sample of correctly categorized admissions (ESI 1 or 2), who were subsequently hospitalized in the ICU, was selected as a comparison group. The global undertriage prevalence was 0.30% (316/104,832). Among patients admitted to the ICU, the prevalence was 21% (316/1,461; 95% confidence intervals (CI) 19-24). The 316 patients whose severity was underestimated had a median age of 73 years, and admitted between 7 a.m. and 9 p.m. in a greater proportion. Overall hospital mortality was 8.9% (95% CI 6.78-11.38), and all deaths occurred after the patient was transferred from the emergency room. There were no differences in mortality between patients with correct triage or undertriage (11 and 7% respectively, p = 0.09). No differences were observed either in the total number of critical interventions during care in the first 24 hours. Significant differences were observed in requirements for mechanical ventilation (11 and 4% respectively, p = 0.01), orotracheal intubation (10 and 5% respectively p = 0.01) and non-invasive ventilation (8 and 4% respectively, p = 0.05). Undertriage rate in this series was low, but it can be improved.

Prevalencia del Cáncer de Esófago y su tratamiento Quirúrgico en un Hospital de alta complejidad durante el periodo enero 2016- diciembre 2018

Prevalencia del Cáncer de Esófago y su tratamiento Quirúrgico en un Hospital de alta complejidad durante el periodo enero 2016- diciembre 2018

Vivencias de madres mapuches durante la hospitalización de sus hijos, en un hospital de alta complejidad del sur de Chile

Introducción: Cuando el cuidado cultural de enfermería reconoce el valor de la cultura, las creencias y modo de vida de los individuos, este se vuelve integral. La pregunta fue ¿Cuál es la vivencia de madres mapuches durante la hospitalización de sus hijos en un hospital de alta complejidad del sur de Chile, 2017-2018? Objetivo general: Develar la vivencia de madres mapuches durante la hospitalización de sus hijos en un hospital de alta complejidad del sur de Chile. Metodología: Se trabajó con etnografía dirigida, con una muestra intencionada de 9 participantes, los criterios de inclusión fueron: madres mapuches hablantes de mapudungun con hijos hospitalizados en servicios pediátricos, en hospital de alta complejidad; que accedan a dar una entrevista grabada, previa firma de consentimiento informado. Se recolectan los datos mediante observación participante, entrevistas en profundidad y notas de campo. Resultados: En la metacategoría vivencia de madres mapuches se identifican las subcategorías: sentido pertenencia a su cultura; complementariedad en la atención, calidad en la atención y discriminación. Conclusión: Se aprecia contrariedades, decepciones y complicaciones en legitimar la diversidad cultural y social, que se traducen en impedimentos, para el éxito de las estrategias de coherencia cultural en salud, ya que emergen trazos de discriminación. Se manifiesta integralidad del mundo indígena que se expresa en las personas a través de sus valores propios de la cultura.

Decision making to discharge patients from airborne infection isolation rooms: The role of a single GeneXpert MTB/RIF strategy in Brazil.

Tuberculosis (TB) transmission in healthcare facilities is still a concern in low-income countries, where airborne isolation rooms are scarce due to high costs. We evaluated the use of single GeneXpert MTB/RIF, the molecular Mycobacterium tuberculosis (MTB) DNA and resistance to rifampicin (RIF) test, as an accurate and faster alternative to the current criteria of 3 negative acid-fast bacilli (AFB) smears to remove patients from airborne isolation. In this real-world investigation, we evaluated the impact of a single GeneXpert MTB/RIF on the decision making for discharging patients from respiratory isolation. We enrolled patients with suspected pulmonary TB in a public hospital that provides care for high-complexity patients in Brazil. We studied the performance, costs, and time saved comparing the GeneXpert MTB/RIF with AFB smears. We enrolled 644 patients in 3 groups based on the number of AFB smears performed (1, 2, and 3, respectively) on respiratory specimens. GeneXpert MTB/RIF demonstrated good performance compared to AFB smear to rule out TB in all groups. The negative predictive value for AFB smear was 94% (95% confidence interval [CI], 0.90-0.97) and 98% (95% CIs, 0.94-0.99) for GeneXpert MTB/RIF in G3. The isolation discharge based on 3 AFB smears took 84 hours compared to 24 hours with GeneXpert MTB/RIF, which represents 560 patient-days saved in the isolation rooms. A single GeneXpert MTB/RIF is a fast and strong predictor for TB absence in a high-complexity hospital, which is quite similar to results obtained in recent studies in low-burden settings. This molecular test may also increase patient rotation through isolation rooms, with a positive impact in the emergency room and infectious diseases wards.

Caracterización clínica y microbiológica de pacientes con pie diabético que requieren hospitalización en alta complejidad. Serie de casos

BackgroundInfected diabetic foot is a frequent complication of diabetes and a marker of patient deterioration. There is little information in Colombia on the characteristics of patients that enter the highly complex emergency services with this condition and their outcomes, such as amputation and microbiological profile. MaterialsCase series of patients admitted to the emergency department of Pablo Tobón Uribe Hospital whose main consultation was infected diabetic foot. The medical records were retrospectively analysed and descriptive statistical tools were used to characterise the population, as well as the variables related to diagnosis, treatment, and early in-hospital outcomes. ResultsBetween January 2009 and December 2013, 118 patients with 145 ulcers due to an infected diabetic foot were admitted. The HbA1c was> 6.5 in 90%, and 52% had renal dysfunction, 51% with peripheral arterial disease, and 57% had ulcers grade 3 or higher in the Wagner classification. The infection was polymicrobial in 63%, and 58% required amputation, with 62% of amputations being classed as minor. Mortality was 10%, and mortality attributable to diabetic foot infection or complications derived from amputation was 1.7%. DiscussionPatients with diabetic foot admitted to the emergency room of a high complexity hospital in Colombia have an advanced systemic disease, related to renal and peripheral vascular dysfunction, and serious local injuries with advanced bone and joint involvement. Given the severity of these conditions, the prevalence of major amputations may be higher than that reported in the literature.Evidence Level: IV

Mortalidade neonatal em hospitais públicos de alta e média complexidade no Baixo Amazonas

Objetivo: Analisar a taxa de mortalidade neonatal nos hospitais públicos de média e alta complexidade do Baixo Amazonas nos anos 2016 e 2017. Métodos: A presente pesquisa foi realizada por meio de um estudo descritivo-analítico, tendo como base a abordagem quantitativa, transversal, documental e comparativa, com base nos dados de prontuários em dois Hospitais da região Amazônica. Resultados: O percentual de neonatos que evoluíram a óbito na UTI neonatal nos anos de 2016 e 2017 foram próximos, com 12,35% e 11,85%, respectivamente. O número total de pacientes internados em 2016 foi de 3192 e em 2017 foram internados 4052. Evoluindo a óbito 82 pacientes em 2016 e 49 pacientes em 2017. Representando um percentual de mortalidade de 2,5% e 1,3% respectivamente. Neste último, 45 prontuários foram encontrados para análise. Conclusão: No geral, houvera prevalência de mães na faixa etária de 16-20 anos (30,2%), residentes em Santarém (59,3%), raça não informada (69,8%), estado civil não informado (36%), com ensino médio completo ou incompleto (34,9%), tiveram gestação única (95,3%), evoluíram para parto vaginal (53,5%) e que realizaram pré-natal (58,1%).

Díadas de cuidado y competencia para cuidar al alta hospitalaria en un hospital de Bogotá

Introducción. Con frecuencia las personas con enfermedades crónicas requieren un cuidado especial en su hogar, siendo en este contexto fundamental la competencia de cuidado. Objetivo. Identificar las características y asociaciones del cuidado informal y de la competencia para cuidar de la díada cuidador-persona con enfermedad crónica, durante el alta hospitalaria en un hospital de alta complejidad de Bogotá – 2016. Metodología. Estudio cuantitativo–descriptivo, transversal-analítico; en la medición se usó la encuesta de caracterización de la díada: cuidador-persona con enfermedad crónica, y el instrumento de competencia de cuidado en el hogar, versión abreviada CUIDAR. Resultados. Participaron 97 díadas. Los cuidadores eran, en su mayoría, mujeres (79,4%) con edad promedio de 43,7 (±15,5) años, con una trayectoria como cuidadores en promedio de 4,3 años. Las personas con enfermedad crónica eran mayormente mujeres (67,0%), con edad promedio de 64,3 años, y con antecedentes patológicos de diabetes mellitus (55,7%) e hipertensión arterial (48,5%). Cuidadores perciben sentir carga (61,9%) y pacientes ser una carga (57,7%); las díadas perciben mínima satisfacción con el apoyo recibido y están más familiarizadas con el uso del teléfono y televisión. La competencia para cuidar fue valorada como alta por el cuidador (44,8 puntos promedio). Dimensiones de la competencia de cuidado se asociaron (p&lt;0,05) con escolaridad, compromiso religioso, carga percibida, edad del paciente, entre otros aspectos. Conclusiones. Las díadas de cuidado cuentan con características relacionadas con el nivel de competencia para el cuidado, estas son de importancia en la estructuración de intervenciones para mejorar el bienestar de los cuidadores.

Carga laboral de los profesionales de enfermería en unidad de cuidados intensivos. Estudio descriptivo: «CARETIME»

IntroductionNursing workload in intensive care units is directly related to the efficiency and quality of care. However, there is limited data on this subject in Colombia, despite the importance of the administration and management of these units. ObjectiveTo describe the workload of nurses in a high complexity ICU in Santander, Colombia. MethodologyA descriptive study was carried out with the professional nursing staff of an ICU of a high complexity hospital between July and November 2018. Nursing Activities Score (NAS) was used to measure the workload. The information was entered into the software EpiData 3.1, and then exported to the statistical package Stata 14.0 where it was analysed using descriptive statistics. ResultsThe most prevalent type of diagnosis was in the infectious category, with 24.0% (n=12). The mean stay in ICU stay was 11 days (Q1:7- Q3:17) and the degree of criticality was calculated with the Sequential Organ Failure Assessment (SOFA) score for each patient, obtaining a mean of 8.1±3.44 points. The mean overall NAS score was 60.51±12.13 (min: 36.6 and max: 92.7). The activity in which nurses spent the most time in the ICU is monitoring and control, with 16.18±4.34 according NAS categories, including mobilisation and positional changes with 9.69±3.97, followed by renal support with 8.71±3.30. ConclusionThe ICU nursing staff use more than half of their shift time to a single patient in the intensive care unit (61). Similarly, direct care activities occupy the largest percentage of their time during this period.

Creencias de los padres acerca de los trastornos mentales de sus hijos en una consulta universitaria en Colombia

ObjectiveDescribe the beliefs of parents about the mental disorders of their children who attended a paediatric outpatient clinic at a university hospital. MethodsThis was a descriptive study with parents of children with mental disorders seen from January to May of 2018 at a high complexity hospital in Medellin, Colombia. Ninety-eight (98) parents of children and adolescents attending their first outpatient consultation with Paediatric Psychiatry were studied. An instrument designed by the investigators was applied to obtain demographic variables and beliefs about the origin of their child's mental disorder, treatment and adjuvants. Results49.9% of the 98 parents believed that their child had a mental disorder. 43.9% believed the disorder was inherited and 41.8% believed its cause was organic. 95.9% of the parents believed the child needed treatment, including psychotherapy (90.4%) and medication (58.51%). Among the alternative treatments the parents believed the child needed, healing was the most commonly cited by 27.5% of the parents. Of the adjuvant methods, the most commonly cited were reinforcing positive behaviour (82.7%) and correcting with words and setting a good example (72.4%). ConclusionsNearly half of the parents believed their child had a mental disorder, the treatment that was most commonly considered was psychotherapy above medication, and the best adjuvant methods cited by parents were reinforcing positive behaviour, correcting with words and setting a good example.

Impact of mammography screening on the treatment of women diagnosed with breast cancer

Objective: To evaluate the influence of mammographic screening on the treatment of women with previous diagnosis of breast cancer. Method: Cross-sectional, descriptive, observational study, with primary and secondary data collection and quantitative approach. It was performed in a high complexity hospital in the South region of Santa Catarina, Brazil, where patients with previous history of breast cancer were evaluated during the period from 2012 to 2017, and who were undergoing oncological follow-up at the same hospital. The variables were expressed as frequency and percentage. Inferential statistical analyses were performed with a significance level of alpha = 0.05 and, therefore, 95% confidence interval. Therefore, the confidence interval was 95%. Associations between variables were investigated using the Pearson’s χ² and the likelihood ratio tests. Results: Among the 99 analyzed patients, 58.6% annually performed the examination and 49.5% had elapsed less than 12 months between the last performed mammogram and the diagnosis. There was a higher frequency of stage I disease, corroborating the results that 74.7% of patients underwent breastconserving surgeries and 68.7% underwent sentinel lymph node biopsy, rather than extensive surgeries. Regarding the treatment of choice, patients with annual or biennial mammographic frequency had similar surgical and chemotherapeutic outcomes in relation to patients who had a mammogram without defined frequency or who had never undergone it. Conclusion: Patients who underwent mammography on an annual frequency and those whose time between the last mammogram and the diagnosis of cancer was less than 12 months had tumors of lesser extent at diagnosis; however, it did not influence the type of treatment chosen.

Activity based costs of different units in a high complexity Chilean hospital

Hospitals must have management tools that allow them to fulfil all their requirements with the allocated resources. To evaluate the number of bed-days according to the discharge diagnosis in a High Complexity Hospital in Chile. An activity Based Cost (ABC) calculation was used. The stages were gathering of procedures, identification of the resources used, analysis of discharge diagnosis, definition of cost objects, resource cost drivers, cost of procedures, procedures cost drivers and cost of the cost objects that corresponds to bed-day by each medical specialty. Costs were calculated for Medical-Surgical and Intermediate Care units. There were significant differences in costs according to medical specialty when comparing the costs obtained using the Management information system (WinSig) and ABC. Respiratory, Renal and Circulatory-Cardiovascular specialties accounted for the most expensive bed-days. This study identified bed-day costs and provides disaggregated information about the causes of cost differences between medical specialties.

Use of the Modified Early Warning Score in intrahospital transfer of patients.

ObjectiveTo verify whether there is an association between the Modified Early Warning Score before the transfer from the emergency room to the ward and death or admission to the intensive care unit within 30 days.MethodsThis is a historical cohort study conducted in a high-complexity hospital in southern Brazil with patients who were transferred from the emergency room to the ward between January and June 2017. The following data were collected: sociodemographic variables; comorbidities, as determined by the Charlson index; reason for hospitalization; Modified Early Warning Score at the time of transfer; admission to the intensive care unit; care by the Rapid Response Team; mortality within 30 days; and hospital mortality.ResultsA total of 278 patients were included in the study. Regarding the Modified Early Warning Score, patients who died within 30 days had a significantly higher score than surviving patients during this period (2.0 [1.0 - 3.0] versus 1.0 [1.0 - 2.0], respectively; p = 0.006). The areas under the receiver operating characteristic curve for death within 30 days and for ICU admission were 0.67 (0.55 - 0.80; p = 0.012) and 0.72 (0.59 - 0.84; p = 0.02), respectively, with a Modified Early Warning Score cutoff of ≥ 2. In the Cox regression, the Modified Early Warning Score was independently associated with mortality within 30 days after multivariate adjustment (hazard ratio 2.91; 95% confidence interval 1.04 - 8.13).ConclusionThe Modified Early Warning Score before intrahospital transfer from the emergency room to the ward is associated with admission to the intensive care unit and death within 30 days. The Modified Early Warning Score can be an important indicator for monitoring these patients and can prompt the receiving team to take specific actions.

Influence of mammography screening in the treatment of women diagnosed with breast cancer

Introduction: Apart from non-melanoma skin tumors, breast cancer is the most prevalent neoplasm among women in Brazil and worldwide. Breast cancer is a very heterogeneous disease, a fact attributed to the plasticity of its cells. Therefore, the stratification of tumors is critical to achieving better clinical outcomes. Breast cancer screening often allows diagnosing the disease in its earlier stages, manifested as smaller tumors, and still without lymph node involvement. The multiple prognostic factors that must be taken into account when considering the eligibility for treatment, such as age, reproductive status, type of cancer, and severity of the disease, make it impossible to establish clear approach guidelines for the disease, given the many different clinical situations. Objectives: To evaluate the influence of mammography screening in the treatment of women with a previous diagnosis of breast cancer. Methodology: This is an observational, descriptive, cross-sectional study conducted with primary and secondary data and a quantitative approach. The research was carried out in a high-complexity hospital in the far-south of Santa Catarina, Southern Brazil, and assessed patients with a previous diagnosis of breast cancer, from 2012 to 2017, who were on oncological outpatient follow-up. Results: Among the 99 patients analyzed, 58.6% undergo the examination annually, and 49.5% were diagnosed less than 12 months after the last mammography. Stage I diseases were more frequent, corroborating the finding that 74.7% of patients were submitted to conservative surgeries and 68.7% to sentinel lymph node biopsy, instead of more extensive procedures. With respect to the treatment of choice, patients with annual or biennial mammography frequency had surgical and chemotherapeutic outcomes similar to those of women who had no set frequency or who had never had a screening, that is, 72.4% of patients with annual frequency and 100% of patients with biennial frequency were submitted to conservative surgery, as occurred with 85% of patients with no set frequency and 66% of those who had never had the test. Conclusion: Patients who had annual mammographies and those diagnosed less than 12 months after the last mammography presented smaller tumors at diagnosis, but these characteristics did not influence the type of treatment chosen.